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Individual

TERESA ANNETTE BLACKSMITH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
US HWY 18, PINE RIDGE IHS, PINE RIDGE, SD 57770
(605) 867-3007
Mailing address
IHS N-21, PINE RIDGE, SD 57770
(605) 867-2581

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R027661
SD

Other

Enumeration date
06/09/2008
Last updated
06/09/2008
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